My OB comes in and holds his hand between my legs. He glances up at the clock. "If you can hold on a minute, this kid's gonna be born famous," he says, but I shake my head.
"Get it out," I tell him. "Now."
The doctor looks at Brian. "Tax deduction?" he guesses.
I am thinking of saving, but it has nothing to do with the IRS. The baby's head slips through the seal of my skin. The doctor's hand holds her, slides that gorgeous cord free of her neck, delivers her shoulder by shoulder.
I struggle to my elbows to watch what is going on below. "The umbilical cord," I remind him. "Be careful." He cuts it, beautiful blood, and hurries it out of the room to a place where it will be cryogenically preserved until Kate is ready for it.
Day Zero of Kate's pre-transplant regimen starts the morning after Anna is born. I come down from the maternity ward and meet Kate in Radiology. We are both wearing yellow isolation gowns, and this makes her laugh. "Mommy," she says, "we match."
She has been given a pediatric cocktail for sedation, and under any other circumstance, this would be funny. Kate can't find her own feet. Every time she stands up, she collapses. It strikes me that this is how Kate will look when she gets drunk on peach schnapps for the first time in high school or college; and then I quickly remind myself that Kate might never be that old.
When the therapist comes to take her into the RT suite, Kate latches on to my leg. "Honey," Brian says, "it's gonna be fine."
She shakes her head and burrows closer. When I crouch down, she throws herself into my arms. "I won't take my eyes off you," I promise.
The room is large, with jungle murals painted on the walls. The linear accelerators are built into the ceiling and a pit below the treatment table, which is little more than a canvas cot covered with a sheet. The radiation therapist places thick lead pieces shaped like beans onto Kate's chest and tells her not to move. She promises that when it's all over, Kate can have a sticker.
I stare at Kate through the protective glass wall. Gamma rays, leukemia, parenthood. It is the things you cannot see coming that are strong enough to kill you.
There is a Murphy's Law to oncology, one which is not written anywhere but held in widespread belief: if you don't get sick, you won't get well. Therefore, if your chemo makes you violently ill, if radiation sears your skin—it's all good. On the other hand, if you sail through therapy quickly with only negligible nausea or pain, chances are the drugs have somehow been excreted by your body and aren't doing their job.
By this criterion, Kate should surely be cured by now. Unlike last year's chemo, this course of treatment has taken a little girl who didn't even have a runny nose and has turned her into a physical wreck. Three days of radiation has caused constant diarrhea, and put her back into a diaper. At first, this embarrassed her; now she is so sick she doesn't care. The following five days of chemo have lined her throat with mucus, which keeps her clutching at a suction tube as if it is a life preserver. When she is awake, all she does is cry.
Since Day Six, when Kate's white blood cell and neutrophil counts began to plummet, she has been in reverse isolation. Any germ in the world might kill her now; for this reason, the world is made to keep its distance. Visitors to her room are restricted, and those who are allowed in look like spacemen, gowned and masked. Kate has to read picture books while wearing rubber gloves. No plants or flowers are permitted, because they carry bacteria that could kill her. Any toy given to her must be scrubbed down with antiseptic solution first. She sleeps with her teddy bear, sealed in a Ziploc bag, which rustles all night and sometimes wakes her up.
Brian and I sit outside the anteroom, waiting. While Kate sleeps, I practice giving injections to an orange. After the transplant Kate will need growth factor shots, and the chore will fall to me. I prick the syringe under the thick skin of the fruit, until I feel the soft give of tissue underneath. The drug I will be giving is subcutaneous, injected just under the skin. I need to make sure the angle is right and that I am giving the proper amount of pressure. The speed with which you push the needle down can cause more or less pain. The orange, of course, doesn't cry when I make a mistake. But the nurses still tell me that injecting Kate won't feel much different.
Brian picks up a second orange and begins to peel it. "Put that down!"
"I'm hungry." He nods at the fruit in my hands. "And you've already got a patient."
"For all you know that was someone else's. God knows what it's doped up with."
Suddenly Dr. Chance turns the corner and approaches us. Donna, an oncology nurse, walks behind him, brandishing an IV bag filled with crimson liquid. "Drum roll," she says.
I put down my orange, follow them into the anteroom, and suit up so that I can come within ten feet of my daughter. Within minutes Donna attaches the bag to a pole, and connects the drip to Kate's central line. It is so anticlimactic that Kate doesn't even wake up. I stand on one side, as Brian goes to the other. I hold my breath. I stare down at Kate's hips, the iliac crest, where bone marrow is made. Through some miracle, these stem cells of Anna's will go into Kate's bloodstream in her chest, but will find their way to the right spot.
"Well," Dr. Chance says, and we all watch the cord blood slowly slide through the tubing, a Crazy Straw of possibility.
JULIA
AFTER TWO HOURS OF LIVING with my sister again, I'm finding it hard to believe we ever comfortably shared a womb. Isobel has already organized my CDs by year of release, swept under the couch, and tossed out half the food in my refrigerator. "Dates are our friend, Julia." She sighs. "You have yogurt in here from when Democrats ruled the White House."
I slam the door shut and count to ten. But when Izzy moves toward the gas oven and starts looking for the cleaning controls, I lose my cool. "Sylvia doesn't need cleaning."
"That's another thing: Sylvia the oven. Smilla the Fridge. Do we really need to name our kitchen appliances?"
My kitchen appliances. Mine, not ours, goddammit. "I'm totally getting why Janet broke up with you," I mutter.
At that, Izzy looks up, stricken. "You are horrible," she says. "You are horrible and after I was born I should have sewed Mom shut." She runs to the bathroom in tears.
Isobel is three minutes older than me, but I've always been the one who takes care of her. I'm her nuclear bomb: when there's something upsetting her, I go in and lay waste to it, whether that's one of our six older brothers teasing her or the evil Janet, who decided she wasn't gay after seven years into a committed relationship with Izzy. Growing up, Izzy was the Goody Two-shoes and I was the one who came up fighting—swinging my fists or shaving my head to get a rise out of our parents or wearing combat boots with my high school uniform. Yet now that we're thirty-two, I'm a card-carrying member of the Rat Race; while Izzy is a lesbian who builds jewelry out of paper clips and bolts. Go figure.
The door to the bathroom doesn't lock, but Izzy doesn't know that yet. So I walk in and wait till she finishes splashing cold water on her face, and I hand her a towel. "Iz. I didn't mean it."
"I know." She looks at me in the mirror. Most people can't tell us apart now that I have a real job that requires conventional hair and conventional clothes. "At least you had a relationship," I point out. "The last time I had a date was when I bought that yogurt."
Izzy's lips curve, and she turns to me. "Does the toilet have a name?"
"I was thinking of Janet," I say, and my sister cracks up. The telephone rings, and I go into the living room to answer it. "Julia? This is Judge DeSalvo calling. I've got a case that needs a guardian ad litem, and I'm hoping you might be able to help me out." I became a guardian ad litem a year ago, when I realized that nonprofit work wasn't covering my rent. A GAL is appointed by a court to be a child's advocate during legal proceedings that involve a minor. You don't have to be a lawyer to be trained as a GAL, but you do have to have a moral compass and a heart. Which, actually, probably renders most lawyers unqualified for the job. "Julia? Are you there?"
I would turn cartwheels
for Judge DeSalvo; he pulled strings to get me a job when I first became a GAL. "Whatever you need," I promise. "What's going on?"
He gives me background information—phrases like medical emancipation and thirteen and mother with legal background float by me. Only two items stick fast: the word urgent, and the name of the attorney.
God, I can't do this.
"I can be there in an hour," I say.
"Good. Because I think this kid needs someone in her corner.”
“Who was that?" Izzy asks. She is unpacking the box that holds her work supplies: tools and wire and little containers of metal bits that sound like teeth gnashing when she sets them down. "A judge," I reply. "There's a girl who needs help." What I don't tell my sister is that I'm talking about me.
Nobody's home at the Fitzgerald house. I ring the doorbell twice, certain this must be a mistake. From what Judge DeSalvo's led me to believe, this is a family in crisis. But I find myself standing in front of a well-kept Cape, with carefully tended flower gardens lining the walk.
When I turn around to go back to my car, I see the girl. She still has that knobby, calf-like look of preteens; she jumps over every sidewalk crack. "Hi," I say, when she is close enough to hear me. "Are you Anna?"
Her chin snaps up. "Maybe."
"I'm Julia Romano. Judge DeSalvo asked me to be your guardian ad litem. Did he explain to you what that is?"
Anna narrows her eyes. "There was a girl in Brockton who got kidnapped by someone who said they'd been asked by her mom to pick her up and drive her to the place where her mom worked."
I rummage in my purse and pull out my drivers license, and a stack of papers. "Here," I say. "Be my guest." She glances at me, and then at the god-awful picture on my license; she reads through the copy of the emancipation petition I picked up at the family court before I came here. If I am a psychotic killer, then I have done my homework well. But there is a part of me already giving Anna credit for being wary: this is not a child who rushes headlong into situations. If she's thinking long and hard about going off with me, presumably she must have thought long and hard about untangling herself from the net of her family.
She hands back everything I've given her. "Where is everyone?" she asks.
"I don't know. I thought you could tell me." Anna's gaze slides to the front door, nervous. "I hope nothing happened to Kate."
I tilt my head, considering this girl, who has already managed to surprise me. "Do you have time to talk?" I ask.
The zebras are the first stop in the Roger Williams Zoo. Of all the animals in the Africa section, these have always been my favorite. I can give or take elephants; I never can find the cheetah—but the zebras captivate me. They'd be one of the few things that would fit if we were lucky enough to live in a world that's black or white.
We pass blue duikers, bongos, and something called a naked mole rat that doesn't come out of its cave. I often take kids to the zoo when I'm assigned to their cases. Unlike when we sit down face-to-face in the courthouse, or even at Dunkin' Donuts, at the zoo they are more likely to open up to me. They'll watch the gibbons swinging around like Olympic gymnasts and just start talking about what happens at home, without even realizing what they are doing.
Anna, though, is older than all of the kids I've worked with, and less than thrilled to be here. In retrospect, I realize this was a bad choice. I should have taken her to a mall, to a movie.
We walk through the winding trails of the zoo, Anna talking only when forced to respond. She answers me politely when I ask her questions about her sisters health. She says that her mother is, indeed, the opposing attorney. She thanks me when I buy her an ice cream.
"Tell me what you like to do," I say. "For fun."
"Play hockey," Anna says. "I used to be a goaltender."
"Used to be?"
"The older you get, the less the coach forgives you if you miss a game." She shrugs. "I don't like letting a whole team down."
Interesting way to put it, I think. "Do your friends still play hockey?"
"Friends?" She shakes her head. "You can't really have anyone over to your house when your sister needs to be resting. You don't get invited back for sleepovers when your mom comes to pick you up at two in the morning to go to the hospital. It's probably been a while since you've been in middle school, but most people think freakhood is contagious."
"So who do you talk to?"
She looks at me. "Kate," she says. Then she asks if I have a cell phone.
I take one out of my pocketbook and watch her dial the hospital's number by heart. "I'm looking for a patient," Anna says to the operator. "Kate Fitzgerald?" She glances up at me. "Thanks anyway." Punching the buttons, she hands the phone back to me. "Kate isn't registered."
"That's good, right?"
"It could just mean that the paperwork hasn't caught up to the operator yet. Sometimes it takes a few hours."
I lean against a railing near the elephants. "You seem pretty worried about your sister right now," I point out. "Are you sure you're ready to face what's going to happen if you stop being a donor?"
"I know what's going to happen." Anna's voice is low. "I never said I liked it." She raises her face to mine, challenging me to find fault with her.
For a minute I look at her. What would I do, if I found out that Izzy needed a kidney, or part of my liver, or marrow? The answer isn't even questionable—I would ask how quickly we could go to the hospital and have it done.
But then, it would have been my choice, my decision.
"Have your parents ever asked you if you want to be a donor for your sister?"
Anna shrugs. "Kind of. The way parents ask questions that they already have answered in their heads. You weren't the reason that the whole second grade stayed in for recess, were you? Or, You want some broccoli, right?"
"Did you ever tell your parents that you weren't comfortable with the choice they'd made for you?"
Anna pushes away from the elephants and begins to trudge up the hill. "I might have complained a couple of times. But they're Kate's parents, too."
Small tumblers in this puzzle begin to hitch for me. Traditionally, parents make decisions for a child, because presumably they are looking out for his or her best interests. But if they are blinded, instead, by the best interests of another one of their children, the system breaks down. And somewhere, underneath all the rubble, are casualties like Anna.
The question is, did she instigate this lawsuit because she truly feels that she can make better choices about her own medical care than her parents can, or because she wants her parents to hear her for once when she cries?
We wind up in front of the polar bears, Trixie and Norton. For the first time since we've gotten here, Anna's face lights up. She watches Kobe, Trixie's cub—the newest addition to the zoo. He swats at his mother as she lies on the rocks, trying to get her to play. "The last time there was a polar bear baby," Anna says, "they gave it to another zoo."
She is right; memories of the articles in the ProJo swim into my mind. It was a big public relations move for Rhode Island.
"Do you think he wonders what he did to get himself sent away?"
We are trained, as guardians ad litem, to see the signs of depression. We know how to read body language, and flat affect, and mood swings. Anna's hands are clenched around the metal railing. Her eyes go dull as old gold.
Either this girl loses her sister, I think, or she's going to lose herself.
"Julia," she asks, "would it be okay if we went home?"
The closer we get to her house, Anna distances herself from me. A pretty nifty trick, given that the physical space between us remains unaltered. She shrinks against the window of my car, staring at the streets that bleed by. "What happens next?"
"I'm going to talk to everyone else. Your mom and dad, your brother and sister. Your lawyer."
Now a dilapidated Jeep is parked in the driveway, and the front door of the house is open. I turn off the ignition, but Anna makes no move to rel
ease her seat belt. "Will you walk me in?"
"Why?"
"Because my mother's going to kill me."
This Anna—genuinely skittish—bears little resemblance to the one I've spent the past hour with. I wonder how a girl might be both brave enough to instigate a lawsuit, and afraid to face her own mother. "How come?"
"I sort of left today without telling her where I was going."
"You do that a lot?"
Anna shakes her head. "Usually I do whatever I'm told."
Well, I am going to have to speak to Sara Fitzgerald sooner or later. I get out of the car, and wait for Anna to do the same. We walk up the front path, past the groomed flower beds, and through the front door.
She is not the foe I've built her up to be. For one thing, Anna's mother is shorter than I am, and slighter. She has dark hair and haunted eyes and is pacing. The moment it creaks open, she runs to Anna. "For God's sake," she cries, shaking her daughter by the shoulders, "where have you been? Do you have any idea—"
"Excuse me, Mrs. Fitzgerald. I'd like to introduce myself." I step forward, extending my hand. "I'm Julia Romano, the guardian ad litem appointed by the court."
She slides her arm around Anna, a stiff show of tenderness. "Thank you for bringing Anna home. I'm sure you have lots to discuss with her, but right now—"
"Actually, I was hoping I could speak to you. I've been asked by the court to present my findings in less than a week, so if you've got a few minutes—"
"I don't," Sara says abruptly. "Now isn't really a good time. My other daughter has just been readmitted to the hospital." She looks at Anna, still standing in the doorway of the kitchen: / hope you're happy.
"I'm sorry to hear that."
"I am too." Sara clears her throat. "I appreciate you coming by to talk to Anna. And I know you're just doing your job. But this is all going to work itself out, really. It's a misunderstanding. I'm sure Judge DeSalvo will be telling you that in a day or so."
She takes a step backward, challenging me—and Anna—to say otherwise. I glance at Anna, who catches my eye and shakes her head almost imperceptibly, a plea to just let this go for now. Who is she protecting—her mother, or herself? A red flag unravels across my mind: Anna is thirteen. Anna lives with her mother. Anna's mother is opposing counsel. How can Anna possibly live in the same home and not be swayed by Sara Fitzgerald?
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